Healthcare Provider Details

I. General information

NPI: 1710683545
Provider Name (Legal Business Name): RYAN JOSHUA QUINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 W 32ND ST STE 300
AUSTIN TX
78705-1917
US

IV. Provider business mailing address

1004 W 32ND ST STE 300
AUSTIN TX
78705-1917
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-3440
  • Fax: 512-406-6513
Mailing address:
  • Phone: 512-324-3440
  • Fax: 512-406-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberV2230
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: